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An investigation of how non-government organisations strive to address the commercial determinants of health

Introduction by Croakey: How do non-government organisations seek to counter the power and influence of industries that can undermine public health?

New research identifies 18 NGO strategies targeting governments or commercial actors, including the use of public protests, disrupting company and shareholder meetings, making documentaries, campaigns directly engaging with the public and pursuing litigation against government or industry.

The review was unable to identify the relative effectiveness or appropriateness of strategies, revealing a gap for future research to explore.

The article below is by Dr Bel Townsend from Australian National University, Dr Katherine Cullerton from University of Queensland, Professor Sharon Friel and Tim Johnson from ANU, Dr Rob Ralston and Professor Jeff Collin from University of Edinburgh, Liz Arnanz from NCD Alliance, Rodney Holmes from Foundation for Alcohol Research and Education, Jane Martin from Food for Health Alliance, and Professor Fran Baum from University of Adelaide.


Bel Townsend, Katherine Cullerton, Sharon Friel and colleagues write:

Public health scholarship has uncovered a wide range of strategies used by industry actors to promote their products and influence government regulation, including lobbying and political donations, engaging in multi-stakeholder platforms, funding research, co-opting health professionals and policymakers, and undermining legitimate science.

Less is known about how public health actors can counter industry power and influence.

Public health actors, including experts, advocates, think tanks and non-government organisations (NGOs), play an important role in the policy process. NGOs are one understudied group of actors who comprise much of civil society and play important roles in holding government and industry actors to account.

To identify what strategies have been used by NGOs across different industry sectors in attempts to influence the commercial determinants of health, we conducted a systematic search of scholarly literature in Web of Science, ProQuest and Scopus with a set of search terms.

Studies were included if they comprised an empirical study, sought to examine ‘NGOs’, were in English, and identified at least one NGO strategy aimed at commercial and/or government policy and practice.

Findings

The review included 144 studies involving NGO engagement across extractive (for example, resource extraction), tobacco, food, alcohol, pharmaceuticals, weapons, textiles and asbestos sectors, as well as a small number of general studies.

This is not representative of all NGO action in all industry sectors, but does provide a range of strategies used by NGOs across a number of domains.

The majority of studies focused on NGO interactions at the country level (79%), followed by the global (19%) and regional levels (2%). There was a geographic spread for country-level studies in the extractive, tobacco and food sectors across Africa, Asia, Latin America and Europe.

Country studies by industry sector

Framework of strategies

To conceptualise the range of strategies used by NGOs, we draw on a political science typology of ‘inside’ and ‘outside’ strategies developed in policy studies.

‘Inside’ strategies involve direct contact with the target actor, such as holding private meetings or responding to government consultations.

In contrast, ‘outside’ strategies aim to generate public attention to the target and increase public and political salience of the issue, such as through public campaigns or public protests.

Applying this typology, we identified 18 types of NGO strategies used across sectors and levels.

Inside strategies targeting commercial actors

We identified five ‘inside’ strategies used by NGOs to target commercial actors directly:

NGOs sought to influence commercial actors directly through the formation of partnerships and multi-stakeholder platforms – a strategy identified in 18 studies. Partnerships included between the World Wildlife Fund and Unilever, Coca Cola, Nokia and Hewlett-Packard, and environmental NGOs partnerships with British American Tobacco.

In several studies, engaging in partnerships was reported to be an incremental strategy by NGOs as part of a longer-term campaign for greater regulation of industry practices, although some studies found that these partnerships enabled corporate actors to have greater influence on policymaking.

A second NGO ‘inside’ strategy was holding private meetings and roundtables with commercial actors, also identified in 18 studies. Private meetings have been used by NGOs to attempt to find commercial allies – for example, through the formation of private NGO-industry roundtables on reducing fossil fuel emissions.

NGOs have also used meetings to target ‘surrogate’ commercial actors in supply chains. While the majority of studies did not analyse the content of NGO-commercial actor meetings in depth, one study of NGO engagement with extractive industries documented the development of NGO-industry terms of engagement.

The third NGO ‘inside’ strategy was engaging with company shareholders, identified in 14 studies. In the majority of these studies, NGOs spoke at company annual general meetings and company board meetings, and targeted shareholders and investors through statements and shareholder resolutions in an attempt to influence corporate behaviour directly.

Fourth, collaborations other than formalised partnerships were identified in 13 studies, including collaborations on sustainability standards, reducing food waste, participation in CSR initiatives and collaborating on reports.

Finally, NGO litigation directly against a commercial actor was a strategy in 20 studies. In South Africa, for example, NGO litigation against pharmaceutical firms over lack of access to HIV/AIDS treatment has resulted in the companies being found guilty of abusing antitrust law.

Outside strategies targeting commercial actors

The most common NGO ‘outside’ strategy targeting commercial actors identified in the studies was NGO monitoring and reporting on practices harmful to health – identified in 56 studies.

NGO monitoring included the development of counter narratives to challenge industry claims and provide alternative evidence on impacts to health. NGO monitoring and reporting on industry-funded front groups, for example, was reported to be successful in Australia, with NGOs targeting pro vaping groups for their tobacco industry links, limiting their influence on policymaking.

In 24 studies, holding protests at industry sites was identified as a strategy. NGO protests have included occupying industry sites, blocking entry to industry sites, breaking into sites, and publicly disrupting company AGMs and shareholder meetings.

The use of boycotts, including consumer boycotts and targeting other commercial actors in the supply chain, was a strategy identified in 13 studies. Most of the studies examined a consumer boycott; for example, campaigns asking consumers not to use a particular extractive product.

A less frequent tactic was NGOs directly engaging with the public to influence commercial actors. Five studies, for example, documented the use of public letter-boxing as a tactic to shame commercial actors though campaign material.

Finally, NGOs’ creative use of alternative spaces was an ‘outside’ strategy identified in 26 studies. Eight studies reported NGOs producing public documentaries that exposed corporate activities and public goods.

Inside strategies targeting government actors

The most prevalent NGO ‘inside’ strategy targeting government and/or intergovernmental actors across the studies was lobbying of policymakers, identified in 54 studies. This occurred through formal policy processes such as submissions, and informal processes such as through hallway corridor conversations with policymakers.

NGOs were also involved in drafting legislation, policies and standards for government actors in 20 studies. In India, NGOs drafted a Code of Conduct at the subnational level on engagement between tobacco industry and government officials.

Third, the provision of technical support and training, was found in 20 studies. Twelve of these studies exploring this NGO strategy were focused on tobacco control in low-income countries. In Turkey, for example, NGOs have run workshops for government officials to counter tobacco industry interference in the development of tobacco control legislation.

NGOs have also targeted government and/or intergovernmental actors directly through litigation, identified in 22 studies. In Indonesia, for example, NGOs successfully litigated in the Supreme Court for public disclosure of mining licenses.

Outside strategies targeting government actors

In contrast to ‘inside’ strategies targeting government, the most common NGO ‘outside’ strategy targeting government was the use of protests and public campaigns calling for greater government intervention and regulation, identified in 43 studies. NGO protests included occupying government sites, parliament, and disrupting global negotiations.

Monitoring and reporting was a second key strategy identified in 23 studies. Unlike monitoring industry actors, as outlined above, this tactic focused exclusively on government. An example is NGOs monitoring government compliance with the WHO Framework Convention on Tobacco Control (FCTC) and International Code on Breastmilk Substitutes.

NGOs also strategically shifted debate from one policy forum to another in an attempt to obtain favourable reception and influence. This strategy of forum shifting was identified in 17 studies.

Most studies explored NGOs forum shifting vertically, from the national to regional and global level. Three studies, for example, explored NGOs forum shifting to the FCTC Conference of Parties to shame high and low income country governments for lack of FCTC tobacco control compliance.

Finally, seven studies explored NGOs proposing and initiating alternative solutions for economic development as an ‘outside’ strategy targeting government.

Through this strategy, NGOs publicly proposed alternative solutions to harmful commercial practices to government as a strategy to convince the public of alternative sources of revenue to commercial practices.

Future research

A majority of the studies in this review identified more than one strategy used by NGOs, yet few studies explicitly noted what combinations of ‘inside’ and ‘outside’ approaches were used and why.

Further, the studies didn’t identify the relative effectiveness or appropriateness of strategies – this is a gap for future research.

It is hoped that this heuristic provides a framework for researchers and NGOs to unpack what makes an effective strategy for different targets of change, and under what conditions different NGO strategies can be useful (and are appropriate).


See Croakey’s archive of articles on the commercial determinants of health

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